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Increasing Accessibility of Laparoscopic Surgery in Low- and Middle-Income Countries

提高低收入和中等收入国家腹腔镜手术的可及性

基本信息

批准号：
10454790
负责人：
TAMARA N FITZGERALD
金额：
$ 18.31万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-21 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10454790
关键词：
Abdomen Address Age Applications Grants Biomedical Engineering Carbon Dioxide Chest Client satisfaction Clinical Clinical Data Clinical Research Color Computers Contract Services Country Data Devices Dimensions Electricity Engineering Environment Equipment Excision Feedback Fiber Optics Finite Element Analysis Foundations Future Gases Health Health Expenditures Home Hospitals Human Human Resources Image Income Industry Standard Infection Interdisciplinary Study Laparoscopes Laparoscopic Surgical Procedures Laparoscopy Lead Length of Stay Lifting Light Maintenance Malignant Neoplasms Measures Mechanics Medical Modification Monitor Operating Rooms Operative Surgical Procedures Outcome Pain Patients Performance Positioning Attribute Postoperative Complications Poverty Power Sources Procedures Quality of life Recovery Regulation Research Resource-limited setting Rural Hospitals Safety Scanning Semiconductors Series Surgeon Surgical incisions System Technology Testing Time Tissues Uganda Universities Work Wound Infection X-Ray Computed Tomography abdominal wall cancer therapy cardiovascular collapse cost design detector feasibility testing improved in vivo industry partner instrument interdisciplinary approach laptop lens light intensity loss of function low and middle-income countries metal oxide operation porcine model pressure prevent prototype repaired response social stigma standard of care surgery outcome targeted imaging

项目摘要

Abstract Laparoscopic surgery is the standard of care in high-income countries (HICs) for many cancer operations in the chest and abdomen. Laparoscopic surgery avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle- incomes countries (LMICs) due to high cost of installment, lack of qualified maintenance personnel, unreliable electricity and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include: decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. Laparoscopic surgery would reduce recovery time, enabling patients to return to home and work more quickly, thereby mitigating impoverishing health expenditure. Laparoscopic technology can be developed that is low-cost, durable, and does not require a constant supply of consumable items or electricity. This would enable laparoscopic surgery to be performed in rural hospitals, where the majority of patients live. We describe a multi-disciplinary collaboration between surgeons and engineers in the U.S. and Uganda to develop a laparoscopic system for use in LMICs. The laparoscopic system will be designed for a cost of goods < $200. Rather than using the current design of fiber optic cables, our prototype has been constructed with low-cost light emitting diodes (LEDs) and a color complementary metal-oxide-semiconductor (CMOS) detector that has been moved to the front of the device. This allows for a maintenance-free and low-cost laparoscope. Images can be displayed on a laptop computer, obviating the need for expensive monitors and cables and preventing loss of function during power-outages. The laparoscopic system also includes a prototype retractor for lift-laparoscopy, which obviates the need for a constant power supply and medical-grade carbon dioxide availability. In the proposed research, the current prototypes will be modified according to feedback from LMIC and HIC surgeons. Safety parameters of the device will be tested in an in vivo porcine model. Clinical data on current laparoscopic cases in Uganda will be collected to assess baseline rates of post-operative complications and difficulties with laparoscopic equipment, which will inform the design of a future clinical study to test the laparoscopic system in a clinical environment.

摘要腹腔镜手术是高收入国家(HICs)许多癌症手术的标准护理胸部和腹部。腹腔镜手术通过使用微型摄像机和细小设备避免了大的切口仪器通过锁孔切割进行操作，但一般不适用于中低档。收入国家(LMIC)，由于分期付款成本高，缺乏合格的维护人员，电力不可靠，消耗品短缺。LMIC中的患者将受益于腹腔镜手术的优点包括：减轻疼痛，缩短恢复时间，减少伤口感染，住院时间也更短。腹腔镜手术将缩短恢复时间，使患者能够恢复到更快地回家和工作，从而减轻贫困的医疗支出。可以开发出低成本、经久耐用、不需要持续不断的腹腔镜技术消耗品或电力的供应。这将使腹腔镜手术能够在农村地区进行。医院，大多数患者居住的地方。我们描述了外科医生之间的多学科合作以及美国和乌干达的工程师共同开发一种用于LMIC的腹腔镜系统。腹腔镜手术系统将以200美元的商品成本进行设计。而不是使用当前的光缆设计，我们的原型是用低成本的发光二极管(LED)和颜色互补器建造的已移动到设备前面的金属氧化物半导体(CMOS)探测器。这允许一个免维护、低成本的腹腔镜。图像可以显示在笔记本电脑上，省去了需要昂贵的显示器和电缆，并防止在停电期间失去功能。这个腹腔镜术系统还包括用于提升-腹腔镜术的原型牵引器，这消除了对恒定的电源供应和医用级别的二氧化碳供应。在拟议的研究中，将根据LMIC和HIC的反馈对当前的原型进行修改外科医生。该装置的安全参数将在活体猪模型中进行测试。当前的临床数据将收集乌干达的腹腔镜病例，以评估手术后并发症的基线发生率和腹腔镜设备的困难，这将为未来临床研究的设计提供信息，以测试临床环境中的腹腔镜系统。